Haematuria

Question 1

What is the definitive way to differentiate between concentrated urine (appearing brown) and visible haematuria?

Answer 1

A urine dipstick test (haematuria will show blood on dipstick, concentrated urine will not).

Question 2

What are the most common causes of haematuria presenting as brown urine? (3)

Answer 2

Renal stones
Renal inflammatory conditions (such as nephritis)
Benign prostatic hyperplasia (BPH)

Question 3

What is a normal residual urine volume (post-voiding)?

Answer 3

<100ml

Question 4

What eGFR is required to safely give a patient contrast prior to an MRI scan?

Answer 4

An eGFR >30ml/min

Question 5

What investigations should be conducted to investigate an enlarged prostate? (3)

Answer 5

-Prostate-specific antigen (PSA) blood test
-MRI scan (with contrast)
-Prostate biopsies

Question 6

What is Contrast-Induced Nephropathy (CIN)?

Answer 6

An acute kidney injury caused by the nephrotoxic effects of IV contrast medium given to patients during radiological investigations, particularly iodine-based contrast agents.

Question 7

How is Contrast-Induced Nephropathy (CIN) defined? (2)

Answer 7

An elevation of serum creatinine of more than 50% of baseline within 48 hours, OR a reduced urine output (<0.5ml/kg/hour) for at least 6 hours.

Question 8

What is prostate-specific antigen (PSA)?

Answer 8

A serine protease, or protein of the prostate, which functions as part of the semen to help its liquefaction.

Question 9

Over what level of prostate-specific antigen (PSA) are suspicions for metastatic prostate cancer much higher?

Answer 9

Over 50 mcg/L

Question 10

What is PIRADS?

Answer 10

A system that rates prostate tissue from 1-5, as to whether it looks normal, or like cancer. (PIRADS score of 5 = presence of cancer is very likely.)

Question 11

What is Gleason Scoring?

Answer 11

A way of defining the aggressiveness of a prostate cancer, where two scores out of 5 are added together to give a score out of 10 (higher score = more aggressive).

Question 12

What are Grade Groups in the context of prostate cancer?

Answer 12

A way of simplifying Gleason Scores, where group 1 is the best prognosis and group 5 is the worst prognosis (a Gleason Score of 9 or 10).

Question 13

What is the difference between active surveillance and watchful waiting?

Answer 13

Active surveillance - regular monitoring tests (PSAs, DREs, MRI and biopsy) but curative treatment only provided if changes occur suggesting progression of disease.
Watchful waiting - also involves waiting to see if symptoms or condition worsen, however check ups are normally done by GP and involve less tests; if treatment does begin at any point, it is usually not curative and just aims to manage symptoms.

Question 14

How frequently is PSA checked during active surveillance?

Answer 14

Every 3-4 months

Question 15

When is an MRI scan repeated during active surveillance?

Answer 15

At 12 months after previous scan

Question 16

What are the treatment options if active surveillance shows worsening disease in prostate cancer? (2)

Answer 16

-Radical prostatectomy
-Radical radiotherapy (given alongside hormone treatments).

Question 17

What are the classical symptoms of metastatic prostate cancer? (6)

Answer 17

-Tiredness
-Weight loss
-Bony aches and pains
-Loss of sensation/power to legs
-Urinary retention
-Constipation

Question 18

Describe the difference between prostate cancer and benign prostate hypertrophy (BPH) on a digital rectal exam (DRE).

Answer 18

In prostate cancer, the prostate will feel hard, irregular and asymmetrical on DRE.
In BPH, the prostate may feel enlarged but smooth and elastic on DRE.

Question 19

What are the ways of achieving androgen deprivation therapy?

Answer 19

-Bilateral orchidectomy
-GnRH analogues/LHRH agonists (given as slow release injections)
-GnRH antagonists/LHRH antagonists

Question 20

What medication can be given to prevent the symptom flare associated with starting GnRH analogues/LHRH agonists for prostate cancer?

Answer 20

2 weeks of anti-androgen drugs

Question 21

What is the International Prostate Symptoms Score (IPSS)?

Answer 21

A commonly used questionnaire in Urology clinics, that gives an objective severity grading to a patient’s symptom.
(Used in NICE guidelines on BPH as a threshold for treatments, and helps determine if treatments have improved the score.)

Question 22

What is nocturnal enuresis?

Answer 22

Involuntary urination whilst asleep (bedwetting).

Question 23

According to NICE, what medication should a patient with voiding Lower Urinary Tract Symptoms (LUTS) be started on (provided they have a small prostate [<30cc] and a PSA<1.5 if applicable)?

Answer 23

An alpha blocker, such as Tamsulosin.

Question 24

What is a hydrocele?

Answer 24

A collection of fluid around the testicle.

Question 25

What is a varicocele?

Answer 25

Abnormal chronic dilatation of the pampiniform plexus.